Mark McClellan on Medicare Drug Plan

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• SUSAN DENTZER:

  Let's talk a bit about what an effort this is to sign up 43 million people — for something many of them are just becoming aware of.

• DR. MARK MCCLELLAN:

  That's right. This is the most important new benefit in Medicare in the program's 40 year history. And so this is the most important outreach and education effort in 40 years. When Medicare began 40 years ago, there was a nationwide effort to reach people in each and every community regardless of where they live, regardless of what kind of circumstance they were in, because this is a program that affects so many people. Today, we are supplying coverage to 43 million Americans in very diverse circumstances, and so we are undertaking an unprecedented effort to give them the information we need to take advantage of this new benefit.

• SUSAN DENTZER:

  What's involved in this effort?

• DR. MARK MCCLELLAN:

  My coordinator for our outreach effort likes to say we're trying to reach Medicare beneficiaries where they live, work and play and pray. And that means we go to lots of different mechanisms. You may be seeing ads on television related to information on the new Medicare benefit. You may read about it in the Medicare handbook, Medicare and You.

  But also a very important part of this outreach effort is community networks. Health and Human Services Secretary Mike Leavitt and I have visited more than 80 communities over the last several months to help set up local networks of health professionals, advocates for seniors, advocates for people with disabilities, church groups, community leaders to work together to help people find out about this important new benefit.

  This is important, not just because people can get new help with their prescription drug costs. It's important because it is a fundamentally new approach in the Medicare program. We're shifting from a program that mainly pays the bills when people get sick. That's something we can do from our main offices in Baltimore. We're trying to turn it into a program that partners with people and their health professionals and family members to help them stay well. And that's something we need to do at a local level all across the country.

• SUSAN DENTZER:

  Let's briefly tick off a few more aspects of this monumental effort and specifically addressing retirees, the people who are eligible for both Medicare and Medicaid, and the larger group of people who are eligible for the low income subsidies. What's involved in dealing with all of those groups?

• DR. MARK MCCLELLAN:

  We have a very diverse population, 43 million beneficiaries and they pay for their health care in many different ways and we are implementing this benefit to serve all of them. One in four people with Medicare, about 10 or 11 million beneficiaries get retiree coverage, coverage from former employers or unions. For them, if they're getting good coverage today, their former employer or union can get new financial help from Medicare directly to help pay for the cost of their coverage. So for these beneficiaries the main thing that they need to know is look for information coming from your former employer union.

  To help make sure they're getting that information we partnered with organizations representing employers and unions around the country. The AFL-CIO, the Business Roundtables in different parts of the country, organizations like the Chamber of Commerce and the National Association of Manufacturers, to get information to each of these retiree programs on how they can best inform their retirees about the new changes and how the retirement coverage will continue to work with these new benefits and financial support for Medicare. That's about 10 or 11 million of our beneficiaries.

  In addition, a lot of people with Medicare who have very low incomes get drug coverage already through state Medicaid programs, either through programs run by the states or with financial support from the federal government to provide health care coverage for people with limited incomes. For these "dually eligible" beneficiaries, our big challenge is to make sure they can take full advantage on schedule of very comprehensive coverage will now come from Medicare. These dual eligible beneficiaries are now going to get their prescription drugs, just like their other medical benefits, primarily from the Medicare program.

  So, to help make sure ensure the transition, we have put in place a whole set of requirements on our prescription drug plans to make sure that these beneficiaries continue to get the drugs that they need. These are beneficiaries often with chronic, multiple medical conditions who often depend on a complex array of multiple medications. We need to keep that working smoothly. We've been working with the states to get information about their drug histories and their current circumstances to the prescription drug plans. And we've implemented, working with pharmacies, a new electronic system so if one of these beneficiaries shows up at a pharmacy in January, and they didn't pay any attention to the outreach efforts and information we've been sending them through the state Medicaid program about the new coverage, they can still walk into a pharmacy and get their drugs that they need in January. So lots of steps to make sure we have smooth transition for those 6 plus million beneficiaries.

  In addition, there are a lot of people with Medicare who have limited incomes, but are not poor enough to qualify for Medicaid. They are eligible for what we call "Extra Help" in the new Medicare coverage. There's extra help available for people who have limited needs. We've been partnering with the Social Security Administration and literally hundreds of organizations around the country that have very different views on politics, very different views about where Medicare should be headed, but they're all working together with one goal in mind right now, which is making sure that these lower income seniors, people with disabilities, take advantage of what Jim Thurman of the Access to Benefits Coalition has called the most important new benefit for older Americans from the federal government in 40 years.

• SUSAN DENTZER:

  And there are an estimated 14 million people eligible for those low income subsidies of whom apparently about 3 million have signed up so far. That's a big gap.

• DR. MARK MCCLELLAN:

  Well, many people will qualify automatically. People who have Medicaid drug coverage, people who have more limited Medicaid benefits qualify automatically. That's around 7½ or 8 million people out of the 14 million who automatically get coverage on day 1, January 1st. We are reaching the rest of the people who are eligible, and again, we tried to learn from history here.

  This is not the first time the federal government is trying to provide extra help for people with limited needs. Going back to the experience of the Medicaid program, the State Children's Health Insurance program, food stamps and other federal benefits to see how, what worked for them in terms of effective outreach. What we saw in all those cases, these can be very hard populations to reach. Medicaid and the Children's Health Insurance Program for example had less than 20 percent of the people eligible enrolled, even after the entire first year of the program.

  What we learned from that was start early and keep it simple. So even before the drug benefit has begun, we've been working with Social Security to send out mailings and to do follow-up contacts and work with many organizations all over the country to reach these individuals. And now, even though we have not yet even started the benefit, more than 3 million people have already sent in applications and we're getting in more applications everyday. So, if we look again at the historical perspective, I think we're going to do a lot better than any previous new federal program to help low income seniors and we're going to do it by partnering, by using lots of different methods to reach the low income population including mailings, contacts by phone, working through local organizations that people know and trust to help them take advantage of this very important benefit.

• SUSAN DENTZER:

  Let's talk about the number of plans that have signed up now to participate in the program. When the law was passed many people said, "Nobody's ever going to play in this market or not sufficient numbers of plans will play in the market. There will have to be a federal fall back." Where do we stand now relative to those earlier concerns?

• DR. MARK MCCLELLAN:

  We're in very good shape in terms of benefits being available to everyone in Medicare with extra coverage at a lower cost than any independent experts had predicted. We've been traveling through rural West Virginia, talking to seniors who often have multiple medical problems and a lot of critics said they're not going to get coverage. People in rural areas, people who have multiple needs, that the drug plans are not going to be around to serve them. We've proven that wrong. There are options for drug coverage everywhere in the country and the costs are lower and the benefits are better.

  People would expect that this is a very important feature of a program that's based on voluntary enrollment and choice. You don't have to sign up and the drug plans know that if they don't provide the coverage that you want, people aren't going to sign up or they're going to go elsewhere and I think that's why you're seeing such strong competition, bringing the cost down, the cost of the drug coverage is turning out to be on average about 15 percent less than independent experts predicted, with lower premiums and lower cost to the government next year. And the options available are even better as well.

  So people who have heard before about problems with the drug benefits, or about drug benefit that they might not want, one that had a deductible, one that had a gap in coverage, so-called donut hole, well it turns out if you don't want those features, you can choose an option that doesn't have it. You can get a coverage that has no deductible, you can get coverage that has no donut hole and that's because of strong competition, because of the plans, knowing that it's not one size fits all. People do not have to sign up. They're only going to choose the coverage that's best for them.

• SUSAN DENTZER:

  In West Virginia, there are now 21 prescription drug plans or PDP's, two to four Medicare Advantage plans depending on the county, all with a range of premiums.

• DR. MARK MCCLELLAN:

  Well here in West Virginia, there are a range of options available. People can get coverage from much less than have been predicted, but drug plan options start at around $10 a month and people even in rural areas, people with multiple medical conditions will have plans to choose from, from 21 organizations participating in the drug benefits. And they're offering multiple options.

  So you can get the basic Medicare benefit at a very inexpensive cost, under 10 or 20 dollars if that's what you want, or you can choose more comprehensive coverage — coverage that fills in the donut hole, coverage that has no deductible, coverage that has a very broad formulary. Even the most costly plans here in West Virginia are in the range of $50 to $60 a month or so for very comprehensive coverage. Now because there are a range of options available, people can get the kind of coverage that meets their needs and we're going to help them make that choice.

• SUSAN DENTZER:

  Now I'd like to talk about the fact that the prices that are coming in at these levels reflect not only an insurance piece of the competition, but also reflect the fact that insurers have been able to negotiate lower drug prices with pharmaceutical manufacturers. So let's talk about that. Why are these prices coming in so low?

• DR. MARK MCCLELLAN:

  The aggressive competition is leading the plans to work hard to get down the cost of their direct coverage. One of the main ways to lower the cost of drug coverage is to negotiate lower prices on the prescription drugs. There's been very aggressive price negotiation going on. Now this is the case where I think a lot of the independent experts got it right. Our independent experts looked at it closely, talked to drug plans who would negotiate aggressively on prices, better or as well as the government can do and get, force people into a one size fits all plan and that's what we're actually seeing. That's a big contributor to the cost of the coverage and so much less than people expected.

• SUSAN DENTZER:

  So this whole debate that the provision of the law that specifically forbade the government from negotiating prices, it sounds like you're saying that's behind us.

• DR. MARK MCCLELLAN:

  We're seeing very aggressive price negotiations. That's what's leading to the lower premiums and lower cost of this coverage to go into the next year than people expected.

• SUSAN DENTZER:

  What do we think this will do to the long term projections of the total cost of the program to the government?

• DR. MARK MCCLELLAN:

  Well, we haven't made any new long term forecasts. Our actuaries make those forecasts twice a year. The next time they'll do it is in early 2006. At that point for the first time, the projections about the cost of the drug benefit will be based on actual information. Up until now, all the figures that people have been using about what the drug benefit will cost were based on expectations, projections of the independent experts. Now we're going to know that by January.

• SUSAN DENTZER:

  Now the upside of this is people have a lot of choices and better choices in terms of prices and coverage. The downside is they've got a lot more choices. For many people that's very, very confusing. A lot of the feedback we were getting today was where people still are very, very confused.

• DR. MARK MCCLELLAN:

  Well, people are just now starting to focus in on what this coverage means. A lot of people haven't yet started spending time thinking about the new benefits of Medicare and start thinking about what the coverage means for them. And it is true that because we now have a range of choices, we've got lower prices and we've got better benefits offered. Now it would be simpler to put everyone in a single government run, government fixed plan where you've go one package of benefits, where people would have a donut hole, where they'd have other features in their coverage that they wouldn't want. By giving people a choice, they can get the coverage that they want.

  And as people start to make that decision about their coverage and the Medicare drug benefit, it's important for them to know number one, they've got time, they can't start signing up for a prescription drug plan until November 15th. As long as you've enrolled by the end of December, you'll get coverage starting on day 1, January 1st, 2006, and if you want more time than that, you have all the way until May 15th, 2006, to make a decision.

  And number two, you don't need to become an expert on every option out there. These are options that are meant to serve our very diverse population of 43 million people to get their health care in different ways, have very different preferences about what kind of coverage they prefer. What you should focus in on is the kind of coverage that you want. You want a basic prescription drug benefit that will provide peace of mind if you have high prescription drug costs and it will help out with your drug expenses on average providing a, a half of the cost of prescription drugs next year. We can get plans like that for under $20 a month all over the country. Or do you want anymore comprehensive benefits? Do you want a drug benefit that will start paying right off the bat, no deductible that would still end that so-called donut hole? You can get that option as well.

  You should start by thinking about what you want and that takes this range of options that are available down to just 2 or 3 or 4 that are a good fit for you. And there will be lots of places to go for help in making this decision. Keep in mind you've got time. You can't even make a decision. You can't sign up until November 15th.

• SUSAN DENTZER:

  Let's talk about the financial penalty. Explain how that works and why people need to keep that in mind.

• DR. MARK MCCLELLAN:

  People have between November 15th and May 15th, 2006, to make a decision about this coverage. This is the open enrollment period. After that, you will pay more for the Medicare Drug Benefit if you don't have coverage that's at least as good as a basic Medicare Benefit. The next chance to enroll will be at the end of 2006 and the penalty is 1 percent per month of the average premium in the drug benefit. So that means if you don't sign up by May 15th, next chance you get to enroll you'll be paying 6 percent more from there on for the cost of your drug coverage.

  This is a penalty that's modeled closely on the way that Medicare Part B works today. Medicare Part B is Medicare's voluntary insurance for physician and outpatient costs. Almost all seniors sign up for it soon after they become eligible for Medicare, and one of the reasons they do, in addition to wanting the protection in case they get sick, even if they're healthy, is they don't want to pay a higher premium later. They don't want to pay the penalty later. And this penalty works in a very similar way.

  It's just like other kinds of insurance. If you were thinking about buying homeowners' insurance, you probably don't want to wait until your house is on fire. The coverage is going to cost a lot more then. Buying it now can give you peace of mind as well as your costs down for the future.

• SUSAN DENTZER:

  Some of the experts are saying that the penalty is not going to be that big a deal and that many people will take the risk of paying it. It might not be a bad risk for them to take if they don't have particularly high drug costs now.

• DR. MARK MCCLELLAN:

  Well, this is voluntary coverage and you don't have to sign up and some people may decide they want to wait until they get sick. They will pay more for their coverage later, but that's the way the insurance works.

  On top of that, I think it's important for people who are healthy to keep in mind that the coverage costs a lot less than those experts expected. And if you can get a drug plan for $10 a month or even less in many parts of the country, and definitely under $20 a month, that's not much of a price to pay for peace of mind now that you'll have the coverage in case you'll need it and protection in the future against higher costs of insurance. We heard from one of the board members of the AARP, he's a retired physician, he's in his 70s. And he says look, I'm one of the lucky ones.

  I'm not taking any prescription drugs at all now, but I'm going to sign up for this coverage on day 1 because I've treated enough patients and people in Medicare to know that there is a good chance that as you get older you're going to develop a condition where prescription drugs can make a real difference. And you don't want to be in a position where you're worried about paying for those thousands.

• SUSAN DENTZER:

  Let's talk about drug, actual drug coverage in the plan, the so-called formulary issue. Again, when the law was passed people said, well let's just wait and see when these plans come out. They probably won't cover a lot of very costly drugs. They may not offer drugs in all the important categories of drugs. Where do we stand now on that issue?

• DR. MARK MCCLELLAN:

  There are two main ways where we worked to make sure that people can get access to all the drugs they need. Number one, we put some specific requirements on all the drug plans about their drug lists, the formularies of drugs hat they cover. Where a specific drug makes a difference, a drug plan has to cover it.

  So for example, for mental illnesses, for HIV and AIDS, for cancer, for drugs for immune conditions, every plan is required to cover essentially all of the drugs that are available, because specific medicines can make a real difference. In other areas drug formularies, the drug plan list may not cover every single medicine. For example for drugs for hay fever, or drugs for heartburn or stomach acid reflux, there are a lot of products on the market now that people are advertising or have heard about them, that work in a pretty similar way. For most people, one of the drugs in these categories will work just fine.

  You don't need to cover all of them, but all the drug plans are required to cover all medically necessary treatments and one option that's available because we're seeing the strong competition, is to get in a drug plan with what's called an open formula, one that covers essentially all the medicines that are out there. If you look at the list of the drugs that are actually covered, most plans cover the vast majority of drugs and some plans cover virtually all the drugs that are commonly used by seniors.

• SUSAN DENTZER:

  When people are shopping for a plan, how much attention should they pay to the issues of what drugs they're on and whether these drugs are covered by the particular plan they're interested in?

• DR. MARK MCCLELLAN:

  Different people are going to choose a drug plan in different ways. As I've talked to a lot of seniors, like here, is to keep coming up to cost, coverage and convenience. Cost includes things like what the premium is, what the deductible is, how much do I have to pay before the plan starts helping me out, and also getting a handle on what it costs to get your medicines. Coverage includes things like whether the donut hole is still there, whether it's a comprehensive benefit, whether the drug list formulary's very, very broad. So people want a very broad comprehensive coverage. Other people want less costly coverage that'll meet their needs at a lower expense. And also people think about convenience. Is there local pharmacy included? Can they get their drugs by mail order?

  Right now a lot of people are just starting to get familiar with the coverage options that are available. Looking at every plan that is out there, focusing in on the ones that reflect what you want in your coverage is a good place to start. One of the things I'd like to emphasize though is that many seniors today are taking drugs that may be more expensive than they need to be to meet their medical needs. All of the Medicare prescription drug plans have to provide access to all medically necessary treatments, but in some cases, those treatments may be less expensive than the drugs that people are taking today.

  A great example of this is generic drugs. Generic drugs are not like knock off purses or knock off watches. They're regulated in just the same way as the brand name drugs by the Food and Drug Administration. They're exactly the same active ingredients and all the same conditions. They work in exactly the same way but they are much cheaper. Many of the Medicare drug plans will be offering generic drugs for just a few dollars per prescription or some plans even had generic drugs that are free. Many plans offer drug coverage for generics, all the way through the coverage gap. So if there's a generic version of your medicine available, it's worth thinking about switching over and getting a plan that gets very good coverage for that generic.

  We'll be providing help to people in understanding how they can save more on their medicines by thinking about some changes, discussing them with their doctor or pharmacist about some changes in the medicines they take.

• SUSAN DENTZER:

  Let's talk about some of the tools Medicare is providing to help people sort out all of this, such as Medicare.gov. What are the primary tools?

• DR. MARK MCCLELLAN:

  Well there are a lot of tools available and I think the important thing to know to start with is you don't have to go on the Internet to get help. There are a lot of our beneficiaries today who do like to go online or they've got adult children who are helping them with their decisions, or family members who like to go online. So you can go to Medicare.gov and get a lot of personalized help with signing up for a prescription drug plan. But if you don't want to go online, there are other options available.

  You can also get personalized help anytime, 24-7 by calling our customer service line, that's at 1-800-MEDICARE and that's open to everyone, not just to Medicare beneficiaries, but also their family members or caregivers. You can also get hope locally. We've formed partnerships with organizations all around the country to provide face to face help, the local help of making a decision about Medicare's prescription drug coverage.

  In each state there's a state health insurance assistance program available that can set up an appointment face to face or they can talk with you over the phone about the options available for you in your are You can find out about the SHIP program in your area, the assistance program in your area by calling 1-800-MEDICARE or by going online to eldercare.gov putting in your county or zip code and get a list of the local resources available in your community to help you make a decision about the Medicare coverage.

  When people go to any of these sources, they can get help in a lot of different ways. We provide basic information on getting started with the Medicare coverage. How you pay for your Medicare today influences what choice is going to be best for you, whether you've got retiree coverage, whether you've got Medigap coverage that you're paying for yourself, whether you're getting coverage through a Medicare Advantage plan, which are our HMO and PPO plans in Medicare. So we give you information focused on your situation.

  And as you get ready to choose a plan, we can give you information on the plan options available in your area. It can be as simple as a one page chart showing some of the main features of each plan in terms of their premiums and deductibles and their coverage and whether they got mail order, and once you've narrowed down the kind of coverage you want, we can provide even more specific help. This is also unprecedented. People never before have had an opportunity to choose their health care coverage knowing exactly what they'll pay for their prescription drugs at their local pharmacy. That's the kind of information you want. We can give it to you as well through our plan finder tool that's available online and will be available through our 1-800-MEDICARE number as well.

  We can also give you information about the drugs on the formularies. The drugs you're taking now, the generic versions, how broad the formulary is overall. So the kind of information that you want to make your decision can be available through these different sources. But we'll recognize that a lot of different people are going to be making their decisions in different ways, so we want to provide help to all of them.There will be information available at whatever level of detail you want, including right now for the prices of your drugs and your pharmacies, there's unprecedented information if that's what you want to help you make a decision. Right now, more generally, and this actually is true today too, so maybe this isn't that different, but today you can get information on the price of your drugs.

  After you've identified a few plans that look like they may be a good fit for you, you can call 1-800-MEDICARE. You can go to our medicare.gov Web site where we have a plan finder. You can enter the prescriptions that you're taking to see where they are on the formularies for the drug plans that look like a good fit for you. So you could find out if they're on the preferred drugs list where you may only pay $10 or $15 per brand name, or $5 for a generic drug, or if the cost would be higher. We have information available on the exact cost of the medicines, if that's what you want there as well. So information will be available in plenty of time to make a decision for people who want to get a good understanding right now what they pay, what they pay for their medicines. They can do that too, now online with the plan finder and looking at the formulary coverage for their specific drugs.

• SUSAN DENTZER:

  With all of the plans coming in — some of them offering extremely low prices, to the shock, really, of a lot of insurance industry analysts — many people are saying, "This can't last." Some plans are going to lose their shirts in this market. We saw what happened in prior incarnations of private health plans in the Medicare program, where plans came in and then plans got out, leaving people high and dry.

• DR. MARK MCCLELLAN:

  Well in the past plans have come in and gotten out not when the plans made different kinds of decisions, but when the government changed the way that it paid. What we've tried to create here is a predictable and effective way to promote competition to make the plans work to serve our beneficiaries as effectively as possible. This is a system that's going to work next year and I think can work for the longer term to help Medicare beneficiaries get coverage that keeps up with modern medicine, to keep cost down and gives them the benefits that they want. That it isn't a one size fits all, set in legislation package, that inevitably will not serve some of our beneficiaries well and will fall behind modern medicine.

  So we've developed a system that can keep this strong competition going. And as long as we continue that system, I think we're going to be in good shape, giving people access to the medicines they need, the lowest possible cost. I think also we have taken a lot of steps to make sure that the plans that are available next year will be able to continue serving Medicare beneficiaries. Every plan had to meet Medicare's review of their financial strength and their financial circumstances. They had to undergo an independent actuarial review to make sure that their numbers added up and that's another step, to help make sure that this coverage will be there for beneficiaries.

  The problem that Medicare had before with health plans came from changes in the way that Medicare paid. The payment rates were cut too much to the health plans and as a result they were not able to provide stable reliable benefits. What we've done this time differently is set up a system that focuses more on competition so that people do have options available and a plan to know that people will not sign up for their coverage unless they really view it as a good deal. That's what's going to help us continue to get the kinds of low cost and additional coverage options that we see in the start of this directive.

• SUSAN DENTZER:

  There are some concerns that what plans are doing this year is under pricing for the benefits, or pricing very close to the margin, to get as much business as possible. Next year they'll jack up their prices and consumers will be hit with a jolt a year from now.

• DR. MARK MCCLELLAN:

  We have a system in place that is clearly delivering on effective competition. A plan that will try to charge a higher premium or not negotiate as aggressively on the drug prices. It's going to end up having higher cost. It's going to end up offering our beneficiaries less. And our beneficiaries have a choice. They can get the coverage that they want. That means that the plan that doesn't do the very best job of lowering drug prices and providing the kind of coverage people want, will not be selected. People will not choose it. They don't have to. They have other options. They're not in a one-size-fits-all plan that they're forced into. They can get the coverage that they want. That's how we're going to keep the cost down just like we did this year.

• SUSAN DENTZER:

  What's the overall message for consumers contemplating signing up for this benefit?

• DR. MARK MCCLELLAN:

  Well it's time to have a conversation about it. This is the most important new benefit in Medicare in 40 years. It's taking Medicare from a program that focused on paying the bills when people get sick to one that partners with you to help you stay well and to help you get the coverage that you want, not the coverage that the government tries to determine what's best for you. So it's time to start thinking about what you want in the Medicare coverage. You don't have to make a decision yet and there are lots of resources and support available in your community and from Medicare to help you make that decision, to help you get the coverage that you need.

  No matter what choice that you make, all of the Medicare drug plans are required to cover all medical necessary treatments. They're all required to offer coverage at least as good as what Medicare basic benefit package and that's a benefit package that will pay for half or more of the drug cost for a typical senior in 2006 and there are benefit options available to provide even more comprehensive coverage. So there are a lot of options available to help you meet your needs. You need to focus in on what you want out of this coverage. We'll help you find that and get into the new benefit and start saving money.

• SUSAN DENTZER:

  What's ahead?

• DR. MARK MCCLELLAN:

  This is program that matters not only to senior and people with disability, but really for all Americans. Even if you're not on Medicare you probably have a parent or a loved one, a family member, someone you care about who is. And this new program can help them stay well, can help them pay for their prescriptions. We're asking all Americans to have a conversation around the day after Thanksgiving about these new changes in Medicare to get the discussion going about how you can take advantage of the coverage and to get started on enrolling in the new coverage, choosing a plan that's good for you.

• SUSAN DENTZER:

  Are you having a conversation with your mother?

• DR. MARK MCCLELLAN:

  Well my mother is in a very special situation. She's in the midst of running for political office and she's made very clear to me that she doesn't intend to retire for at least four more years. But I will keep talking with her with my other family members who are touched by the Medicare program so they can take advantage of it too. And you know that's what's really special about being in this job right now. One of the sayings that I grew up in my family is it's not the dollars you make, it's the difference you make. And by working together with people all over the country, health professionals, advocates for seniors and people with disability, our local office of Social Security, we have unprecedented effort to bring modern health care to the Medicare program to help people stay well, just as much as we help them when they've gotten sick. So it's a real special privilege to be here and have the powers available to carry on these important conversations to bring better coverage to the Medicare program.

• SUSAN DENTZER:

  And now let me just ask you a question about this bus. How many hours have you logged on this bus in the last few months?

• DR. MARK MCCLELLAN:

  I have lost track of my hours on the bus. The good thing about it is we've got a very nice driver. He's very patient with me. We've been to collectively over 80 different communities in the last several months. We've got a lot more ahead. I've lost track of the hours, but I got to tell you, it's a great way to see the country and a great way to form some new partnerships with the Medicare program and local organizations to help bring better coverage to seniors.

• SUSAN DENTZER:

  Now you know all of the nuts and bolts of this program, but was there anything that you heard on all of these conversations with individuals that surprised you? Anything you weren't expecting?

• DR. MARK MCCLELLAN:

  Every time I go out I learn something new about how we can reach more of our beneficiaries. Every time I hear about new types of beneficiaries we haven't thought about before. I was talking earlier today to one of our beneficiaries who is a Christian Scientist and they don't believe in taking medications, but as Medicare moves into being more of a wellness oriented program, there are a lot of support programs that many of our Medicare advantage plans offer that can help her. I hear often about ideas about how we can reach beneficiaries who are shut in, beneficiaries who face language barriers, beneficiaries who otherwise might not hear about the new coverage.

  For example, in some communities we're working with Meals on Wheels program to reach seniors that otherwise might not have much contact with outside organizations and ability to find out about the coverage. But that's why these local contacts are so important. People in the local communities have the very best ideas about how to reach all of their constituents. And that's why they're such an important part of our outreach efforts.

• SUSAN DENTZER:

  A year ago the Kaiser Family Foundation did a survey suggesting that one in 10 eligible beneficiaries would sign up. Now many people are saying, well one in five are likely to sign up. So that's better but it's still only one in five. What do you think enrollment is going to be?

• DR. MARK MCCLELLAN:

  Well, a lot more people are becoming interested in the program. As people hear more about it more and more of them are interested in signing up. And in fact, if you look at people who say in these surveys that they don't want to sign up, they're actually doing it for the right reasons. They're saying they already have employer coverage, retiree coverage is good. You know that is exactly the way the Medicare benefit was designed. We provide subsidies to help continue that coverage and people tend to stay in it. They don't need to join one of the new Medicare plans. So if you pull all that together what you see is a lot more people expecting to take advantage of the new Medicare coverage. And I expect that interest is going to continue to grow.

  I don't have a specific number in mind for people who are actually going to enroll next year. There are a lot of independent projections out there. I think many of the analysts who follow the health care system closely are expecting around 28 million people, something like that. Could be more, could be less. My main goal is making sure that every Medicare beneficiary who wants to sign up can do so. They can get help enrolling if that's what they need and they will have a drug plan available no matter where they live, no matter what their health status is, no matter what their income is, it will pay for the prescription drugs they need and we're on track for doing that.